From the Guidelines
The primary treatment for patients with positive Transglutaminase Antibody (tTG-AB) labs is a strict, lifelong gluten-free diet. This means complete elimination of wheat, barley, rye, and sometimes oats from the diet, as these grains contain the protein gluten which triggers the autoimmune response in celiac disease. Patients should avoid all foods containing these grains including bread, pasta, cereals, baked goods, and many processed foods that may contain hidden gluten. The diet should be implemented immediately after diagnosis, even before intestinal biopsy confirmation in symptomatic patients with strongly positive antibodies. No medications are typically prescribed as primary treatment, though supplements like iron, folate, vitamin D, calcium, and B12 may be needed initially to correct deficiencies. Nutritional consultation with a dietitian experienced in celiac disease management is essential for education and support. The gluten-free diet works by removing the triggering antigen (gluten), which allows intestinal healing and prevents further autoimmune damage. Most patients experience symptomatic improvement within weeks, though complete normalization of antibody levels and intestinal healing may take 6-24 months of strict adherence to the diet.
Key Considerations
- The gluten-free diet should be implemented immediately after diagnosis, even before intestinal biopsy confirmation in symptomatic patients with strongly positive antibodies 1.
- Nutritional consultation with a dietitian experienced in celiac disease management is essential for education and support 1.
- The diet should be strict and lifelong, with complete elimination of wheat, barley, rye, and sometimes oats from the diet 1.
- Supplements like iron, folate, vitamin D, calcium, and B12 may be needed initially to correct deficiencies 1.
Monitoring and Follow-up
- Type 2 transglutaminase antibody (TG2Ab) titres should be regularly monitored, as persistent elevation is suggestive of gluten exposure 1.
- Nutritional testing in patients on a gluten-free diet (GFD) should be based on deficiencies observed at diagnosis, with special attention to iron, vitamin D and metabolic parameters 1.
- Evaluation by a specialist dietician for the assessment of GFD adherence appears to perform better than adherence questionnaires 1.
From the Research
Primary Treatment for Patients with Positive Transglutaminase Antibody (AB) Labs
The primary treatment for patients with positive Transglutaminase Antibody (AB) labs is a strict gluten-free diet (GFD) 2, 3, 4, 5, 6.
Key Aspects of Treatment
- A gluten-free diet plays a key role in the treatment of celiac disease (CD), which is often associated with positive Transglutaminase Antibody labs 2.
- The effectiveness of the gluten-free diet can be assessed through various means, including the monitoring of anti-transglutaminase antibodies, although these antibodies may not always correlate with histologic recovery 2, 3.
- Small bowel biopsy is still necessary to ensure that the gluten-free diet is adequate, as a substantial number of celiac patients with negative tissue transglutaminase or endomysial antibodies may still have manifest mucosal villous atrophy 3.
- The detection of deposited anti-tTG at the site of inflammation appears to provide a high sensitivity and specificity using a technique that is quick, simple, and reliable 4.
Monitoring and Follow-Up
- Monitoring patients with celiac disease on a gluten-free diet using tissue transglutaminase IgA assays can have different outcomes depending on the assay used 6.
- The normalization of antibody levels can be delayed when using certain assays, and the sensitivity of these assays can vary in detecting suboptimal treatment response in CD 6.
- IgA-tTG-ab and IgA-EMA titers are correlated to transgression levels and one to another in the whole patient population, as well as in the noncompliant group 5.